title: Psychiatric disorders and major spine surgery: epidemiology and perioperative outcomes.
abstract: METHODS
  Analysis of the National Hospital Discharge Survey database from 1990 to 2007.
  
  
  OBJECTIVE
  To evaluate the influence of preoperative depression, anxiety, schizophrenia, or dementia on in-hospital (1) adverse events, (2) mortality, and (3) nonroutine discharge in patients undergoing major spine surgery.
  
  
  BACKGROUND
  Psychiatric comorbidity is a known risk factor for impaired health-related quality of life and poor long-term outcomes after spine surgery, yet little is known about its impact in the perioperative spine surgery setting.
  
  
  METHODS
  Using the National Hospital Discharge Survey database, all patients undergoing either spinal fusion or laminectomy between 1990 and 2007 were identified and separated into groups with and without psychiatric disorders. Multivariable regression analysis was performed for each of the outcome variables.
  
  
  RESULTS
  Between 1990 and 2007, a total estimated number of 5,382,343 spinal fusions and laminectomies were performed. The prevalence of diagnosed depression, anxiety, and schizophrenia among the study population increased significantly over time. Depression, anxiety, schizophrenia, and dementia were associated with higher rates of nonroutine discharge. Depression, schizophrenia, and dementia were associated with higher rates of adverse events. Dementia was the only psychiatric disorder associated with a higher risk of in-hospital mortality.
  
  
  CONCLUSIONS
  Patients with preoperative psychiatric disorders undergoing major spine surgery are at increased risk for perioperative adverse events and posthospitalization care, but its effect in perioperative mortality is more limited. Presurgical psychological screening of candidates undergoing spine surgery might ultimately lead to the enhancement of perioperative outcomes in this growing segment of the US population.
  
  
  METHODS
  N/A.
authors.affiliation: *Orthopaedic Hand and Upper Extremity Service, Massachusetts General Hospital, Boston, MA; and †Orthopaedic Spine Service, Boston, MA.
authors.forename: Mariano E
authors.initials: ME
authors.lastname: Menendez
authors.forename: Valentin
authors.initials: V
authors.lastname: Neuhaus
authors.forename: Arjan G J
authors.initials: AG
authors.lastname: Bot
authors.forename: David
authors.initials: D
authors.lastname: Ring
authors.forename: Thomas D
authors.initials: TD
authors.lastname: Cha
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D007796:Laminectomy / Q000523:psychology* / Q000639:trends; D008297:Male; D001523:Mental Disorders / Q000453:epidemiology / Q000523:psychology* / Q000601:surgery; D008875:Middle Aged; D010351:Patient Discharge / Q000639:trends; D059035:Perioperative Period / Q000523:psychology* / Q000639:trends; D011183:Postoperative Complications / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology*; D013123:Spinal Fusion / Q000523:psychology* / Q000639:trends; D016896:Treatment Outcome